Health-related quality of life after otologic surgical treatment for chronic otitis media: systematic review

ObjectiveThis systematic review aims to describe the impact of otologic surgery as a treatment for chronic otitis media (COM) on the Health-Related Quality of Life (HRQoL) of adult patients.MethodsA literature search was performed in PubMed, Scopus, Embase, and Web of Science until May 2023. Prospective studies including adult patients with COM (cholesteatoma) who underwent canal wall up mastoidectomy, canal wall down mastoidectomy, or tympanoplasty without mastoidectomy, with pre- and postoperative HRQoL measurements, were considered eligible. Questionnaire validation studies were excluded. The risk of bias and study quality were evaluated with a Quality Assessment Tool (for before-after studies with no control group). To assess the change in HRQoL, pre- and postoperative HRQoL values and absolute changes were extracted, synthesized, and presented in tables. Standardized mean differences (SMD) were calculated to enhance comparisons.ResultsOf the 720 studies identified, 16 met the inclusion criteria of this review. Different questionnaires were used throughout the studies. The CES and COMOT-15 were used in five studies and the ZCMEI-21 and COMQ-12 in three studies. All studies indicated statistically significant improvement in HRQoL from pre- to postoperative, measured with disease-specific HRQoL questionnaires. General HRQoL questionnaires did not show significant improvement. Calculated SMDs ranged from 0.24 to 6.99.Discussion and conclusionIncluded studies had low (n = 10) to high (n = 6) risk of bias and poor (n = 4), fair (n = 7) or good (n = 5) study quality. Surgical treatment positively impacts the HRQoL of adult COM patients with and without cholesteatoma. However, the clinical relevance of the reported changes is unknown due to the lack of minimal clinically important differences (MCID) or cut-off values in each questionnaire. Therefore, further research regarding the MCIDs of each questionnaire is needed. Future research should also report preoperative chief symptoms and indications for surgery to improve individual patient counseling

Canal wall up surgery with mastoid and epitympanic obliteration in acquired cholesteatoma

Objectives/Hypothesis: The objective of this study was to evaluate surgical outcome and residual and recurrence rates of canal wall up (CWU) surgery with obliteration of the mastoid and epitympanum. Study Design: Retrospective cohort study in a tertiary referral center. Methods: Patients with (sequelae of) acquired cholesteatoma treated with primary or revision CWU surgery with obliteration of the epitympanum and mastoid were identified retrospectively from 2010 to 2014. Obliteration was performed with cartilage chips or a periosteal midtemporal flap in combination with bone pâté and/or hydroxyapatite. Patients were followed up with micro-otoscopy and magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI). Results: Ninety-nine ears in 96 patients were managed with obliteration of the epitympanum and mastoid following CWU surgery. Mean postoperative follow-up was 39.6 (standard deviation [SD] = 16.3). Mean follow-up until the last MRI-DWI was 29.7 months (SD = 16.0). In total, 74 ears in 72 adult patients (mean age = 46.8 years) were operated and 25 ears in 24 pediatric patients (mean age = 12.8 years). The overall recurrence rate was 7.1%, and the residual rate was 7.1%. In comparison, before the introduction of obliteration, the residual rate in our clinic was 24.4% and the recurrence rate 39.7%. After CWU surgery with obliteration, recurrence in pediatric patients (16.0%) was more frequent than in adults (4.1%). Although this difference was not statistically significant, a trend was observed (P =.066). Conclusions: Obliteration of the epitympanum and mastoid is a reliable and safe technique following CWU surgery for cholesteatoma, resulting in low residual and recurrence rates. Level of Evidence: 4 Laryngoscope, 2018

Ingestie van corpora aliena bij kinderen

Foreign body ingestion occurs frequently in children and may lead to severe complications and mortality. In this article, three cases are presented. A 2-year-old boy swallowed a plastic toy helmet. He had no symptoms and physical examination was normal, and the toy was found in the stool within three days. Similarly, a 6-year-old girl swallowed two magnets and was asymptomatic. Physical examination was normal and a radiograph showed a foreign body which had passed the stomach. Due to the location, endoscopic removal by gastroduodenoscopy was not possible and surgical removal unnecessary. The magnets were secreted in the stool within two days. A 10-year-old boy with VACTERL association and psychiatric history, swallowed a button battery. After a delay in presentation, a radiograph showed a button battery mid-esophageal, which was endoscopically removed. He also needed dilatation due to esophageal stenosis. The above cases are all illustrative of the topic covered in the guideline 'Ingestion of foreign bodies in children aged 0-18 years', which was developed on behalf of the Dutch Pediatric Association and published in March 2019

Measuring growth of residual cholesteatoma in subtotal petrosectomy

Background: Little is known about the growth rate of cholesteatoma in patients. Objective: Investigate the growth of residual cholesteatoma in subtotal petrosectomy based on volume measured in MRI scans. Materials and methods: Retrospective case series in a Tertiary Medical Centre. Thirteen residual cholesteatomas were identified in 10 patients after subtotal petrosectomy for which a wait-and-scan policy was adopted. Volume of the residual cholesteatoma was calculated by manual segmentation as well as the ‘box method’. Results: Mean growth rate was 27.9 mm3/month (SD 22.8), with a large individual variation ranging from 2.2 to 69.8 mm3/month. No complications were reported in 10 patients with a wait-and-scan policy for residual cholesteatoma in subtotal petrosectomy. The box method overestimates growth rate compared to the reference method manual segmentation and a linear increase of this systematic error was seen with increasing size of the cholesteatoma. Conclusions: Residual cholesteatoma growth rate shows a large individual variation. A wait-and-scan policy could be considered in case of a (small) residual in subtotal petrosectomy with ample room to grow before destroying any remaining structures. Furthermore, the clinically more applicable and less time-consuming box method can be used to accurately measure volumes of small cholesteatomasup to a volume of 500 mm 3

Risk of rebleeding after treatment of acute hydrocephalus in patients with aneurysmal subarachnoid hemorrhage

BACKGROUND AND PURPOSE: Cerebrospinal fluid drainage is often indicated in patients with acute hydrocephalus after aneurysmal subarachnoid hemorrhage but is believed to increase the risk of rebleeding. We studied the risk of rebleeding in patients with subarachnoid hemorrhage during treatment for acute hydrocephalus. METHODS: We included patients with hydrocephalus treated with external ventricular drainage or lumbar punctures within 4 days after the hemorrhage and before aneurysm occlusion. Each treated patient was matched with a control patient with untreated hydrocephalus and a control patient without ventricular enlargement. Patients and controls were matched for interval since subarachnoid hemorrhage, duration of exposure, use of tranexamic acid, clinical condition on admission, and age. We used Cox regression to calculate hazard ratios and we adjusted for rebleeding that had occurred before starting the cerebrospinal fluid drainage. RESULTS: In the group treated with external ventricular drainage, rebleeding occurred in seven of 34 patients (21%) with treatment, in seven of 34 controls (21%) with untreated hydrocephalus, and in six of 34 controls (18%) without hydrocephalus. In the group treated with one or more lumbar punctures, rebleeding occurred in one of 21 patients (5%) with treatment, in three of 21 controls (14%) with untreated hydrocephalus, and in none of the 21 controls without hydrocephalus. The hazard ratios for rebleeding were 1.0 (95% CI: 0.4 to 2.7) for external ventricular drainage treatment and 0.7 (95% CI: 0.1 to 6.4) for lumbar puncture treatment. CONCLUSIONS: This study does not confirm an importantly increased risk of rebleeding during external ventricular drainage or lumbar punctures for acute hydrocephalus after aneurysmal subarachnoid hemorrhag

Differences in cartilage-forming capacity of expanded human chondrocytes from ear and nose and their gene expression profiles

The aim of this study was to evaluate the potential of culture-expanded human auricular and nasoseptal chondrocytes as cell source for regeneration of stable cartilage and to analyze the differences in gene expression profile of expanded chondrocytes from these specific locations. Auricular chondrocytes in monolayer proliferated less and more slowly (two passages took 26.7 ± 2.1 days and were reached in 4.37 ± 0.30 population doublings) than nasoseptal chondrocytes (19.3 ± 2.5 days; 5.45 ± 0.20 population doublings). However, auricular chondrocytes produced larger pellets with more cartilage-like matrix than nasoseptal chondrocytes (2.2 ± 0.71 vs. 1.7 ± 0.13 mm in diameter after 35 days of culture). Although the matrix formed by auricular and nasoseptal chondrocytes contained collagen X, it did not mineralize in an in vitro model or after in vivo subcutaneous implantation. A DNA microarray study on expanded auricular and nasoseptal chondrocytes from the same donors revealed 1,090 differentially expressed genes. No difference was observed in the expression of known markers of chondrogenic capacity (e.g., collagen II, FGFR3, BMP2, and ALK1). The most striking differences were that the auricular chondrocytes had a higher expression of anabolic growth factors BMP5 and IGF1, while matrix-degrading enzymes MMP13 and ADAMTS5 were higher expressed in nasoseptal chondrocytes. This might offer a possible explanation for the observed higher matrix production by auricular chondrocytes. Moreover, chondrocytes isolated from auricular or nasoseptal cartilage had specific gene expression profiles even after expansion. These differently expressed genes were not restricted to known characterization of donor site subtype (e.g., elastic), but were also related to developmental processe